Impella: Difference between revisions
From Bay Area Structural Heart Wiki
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*Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes. | *Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes. | ||
*Put input 4in1 B on V-integration 2 for TTE on the fluoro screen. | *Put input 4in1 B on V-integration 2 for TTE on the fluoro screen. | ||
* | *Place drape over legs after surgical draping to cover abdomen. | ||
*Put OR light camera in place to see the surgical site to monitor progress from control room. | *Put OR light camera in place to see the surgical site to monitor progress from control room. | ||
*Ask OR for 1 pack Ray-Tec sponges for wipes. | *Ask OR for 1 pack Ray-Tec sponges for wipes. | ||
*Do the thing (Insert 5.0 Impella) | *Do the thing (Insert 5.0 Impella) | ||
Revision as of 20:36, 16 September 2021
Note: Good article on Single access and sheaths: Impella Single Access
Daniels/Spies single access Impella - DRAFT
Equipment
- 16F Dryseal
- 8fr guide
- 6fr Shuttle 90cm
Hybrid OR Impella via Subclavian conduit
Note: Change location of supplies to Cath Lab 1!
Equipment
- Pack*
- JR4
- Angled Pigtail
- .025 exchange for BP removal
- Perclose
- .035 exchange
- 18” cover for foot pedal*
- 500ml bag heparinized saline
- *Trust me on this...
Procedure
- Enter an order for CCL in EPIC
- Open x-ray and McKesson using entered order.
- DO NOT CHARGE FOR THE PROCEDURE. This is OR's procedure.
- CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- Free-Text note that McKesson is open for billing and equipment only, not procedural charting. See Anesthesia and OR nurses notes.
- Put input 4in1 B on V-integration 2 for TTE on the fluoro screen.
- Place drape over legs after surgical draping to cover abdomen.
- Put OR light camera in place to see the surgical site to monitor progress from control room.
- Ask OR for 1 pack Ray-Tec sponges for wipes.
- Do the thing (Insert 5.0 Impella)
- Remove the other thing (ECMO / Balloon pump / Impella)
- Document times and doses in McKesson and log book.
- Reminder::: CHANGE LOCATION OF ALL SUPPLIES TO CATH LAB 1!!!!!!!!!!!!!!!!!!!!!!!!!!!!
- Save 2 stickers
- Close x-ray and archive to EMIM_CATH
- Capture charges for McKesson
- Print device usage.
- Sticker goes in room 14 log book for tracking, second sticker is for device list
Axillary Impella/IABP - DRAFT
If left subclavian is occluded or otherwise inaccessible procedure is aborted. IABP should not be inserted through right subclavian per CT surgery.
Equipment
- Micropuncture
- Probe Cover
- 4/5F slender radial sheath
- Amplatz extra stiff 260cm wire (on standby for Spies)
- .035 150cm J wire
- 5f pigtail catheter
- 5f JR4 diagnostic catheter (on standby for Spies)
- IABP kit
- 8 23cm safesheath (ep)(Romick) / 8fr x 23 brite-tip sheath (Spies)
- Perclose
- TR band
- Biopatch
- 0-Ethibond suture
- Tournaquick (carrot top)
- 3 Port Manifold
Procedure
- Prep left side neck and chest (ear to nipple and shoulder to midline).
- Note: The access site is not an absolute (may become axillary or subclavicular) hence the large site prep.
- Prep left radial.
- Left radial accessed and 4/5f slender sheath inserted.
- Pigtail advanced and angiogram performed. Pigtail left in place and used as reference for subclavian access.
- Subclavian accessed with ultrasound and fluoro guidance using micropuncture kit and radial sheath inserted.
- Pigtail catheter removed.
- J wire and JR4 inserted and directed to descending aorta if unable to be directed to abdominal aorta
- Catheter and sheath removed, 8f dilator inserted, and perclose advanced for pre-closure.
- Amplatz wire advanced, perclose removed, 8f sheath advanced.
- IABP inserted.
- Sheath peeled away. (Romick)
- IABP secured with suture and site dressed.
- Radial sheath removed and TR band applied.
